Cervical cancer screening utilization and associated factors among female health workers in public health facilities of Hossana town, southern Ethiopia: A mixed method approach

Backgrounds Worldwide, a substantial proportion of women have low cervical cancer screening services utilization. There is a paucity of evidence in utilization of cervical cancer screening services among female health workers and inconsistent findings in Ethiopia. This study aimed to assess the utilization of cervical cancer screening services and associated factors among female health workers in public health facilities of Hossana town, Southern Ethiopia. Methods Facility-based cross-sectional study design complemented with the qualitative inquiry was conducted among randomly selected 241 study participants in Hossana town from June 1 to July 1, 2021. Logistic regression models were used to determine the association between dependent and independent variables with the assumption of a variable with a p-value < 0.05 was considered statistically significant. Qualitative data were transcribed verbatim then translated to English and analyzed using open code version 4.03. Results Out of the total study participants, 19.6% was screened for cervical cancer. Having a diploma level of education (AOR = 0.48;95%CI:0.24,0.98), having three or more children (AOR = 3.65;95%CI:1.44,9.21), having multiple sexual partners(AOR = 3.89;95%CI: 1.38,11.01), and knowledge of cervical cancer screening (AOR = 2.66;95% CI:1.19,5.95) were statistically significantly associated with cervical cancer screening utilization. In-depth interviews suggested additional barriers for low screening utilization including lack of health educational materials, limitation of service to a specific area, service interruption, provider incompetency, and miss-trust and lack of attention by a trained provider. Conclusion Utilization of cervical cancer screening service among female health workers is low. Having a diploma level of education, having three or more children, a history of multiple sexual partners, and knowledge about cervical cancer were predictors of cervical cancer screening utilization. Contextualized health talks and promotion through training with a special focus on low level of knowledge, had lower educational level, and the availability of cervical cancer screening services are critical.


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Cervical cancer screening is watching for precursors before a person has any symptoms 58 and has the benefit to reduce the incidence and the progression to an advanced stage of 59 cancer as well as its mortality [5].  The lower rate of cervical cancer screening at low-income countries may be related to 65 the complexity of screening service and the common inherent barriers in the setting such 66 as other socio-cultural issues, limited access to information, lack of knowledge of cervical 67 cancer, lack of healthcare infrastructure required, lack of trained practitioners and the 68 absence of sustained prevention programs [9]. workers who were working in selected public health facilities of Hosanna town and whose 112 age is 21 and above were included in this study. Critically ill female health workers who 113 had a total hysterectomy, and were on leave during data collection time were excluded 114 from the study.

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Sample size determination and sampling technique 116 The sample size was calculated by applying two population proportion formulas using 117 Epi-Info version 7 and taking a 5% margin error, 80% power, and a 1:1 ratio of an 118 exposed group to a non-exposed group (r = 1 For each health facility, a sampling frame was prepared from the payroll of the human 129 resources department in each public health facility in Hosanna town (Fig 1).  questions was "yes" or "no". Each correct answer was given a score of 1 while an incorrect 157 answer was given a score of 0. We obtained composite knowledge ranging from 0 to 10 158 points. The scores from all 10 items were summed up and the mean sums of total scores 159 were calculated. A female health worker who obtained scores of the mean and greater 160 than the mean score was considered to have good knowledge and who obtained less 161 than the mean score were considered to have poor knowledge [15].

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Attitude/perception of female health workers towards cervical cancer screening was 163 assessed using a likers scale which ranges from score five (strongly agree) to score one 164 (strongly disagree). The responses were summed and a total score was obtained. Then     screening.

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The limitation of this study is the fact that since the study design was a cross-sectional 475 study, temporal relations could not be established. In addition to this, since it is a facility- The study revealed the magnitude of cervical cancer screening service utilization among 487 female health workers is relatively lower than the Ethiopian national guideline for cervical 488 cancer prevention and control that recommended coverage for the target group. This study was not funded. All contributed significantly and gave the final approval for the paper to be published; 516 agreed to be accountable for all impacts of the work.

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Disclosure statement 518 The authors declare that there is no conflict of interest in this work.

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Permission to conduct the study was obtained from Hawassa University, College of 524 medicine and health sciences research ethics review committee. Written and signed 525 informed consent were obtained from each study participant and head health facilities 526 before the interview. The data collection procedure was anonymous to keep the 527 confidentiality of any information provided by the study participants.